Wrinkles, brown spots, and cancer: Relationship between appearance- and health-based knowledge and sunscreen use.

BACKGROUND: There is increasing understanding that sunscreen use is associated with reduced photoaging and that appearance-based messages are more effective than health-based messages in promoting daily sunscreen use. We hypothesized that persons with greater awareness of the effects of photoaging use sunscreen more consistently. METHODS: Cross-sectional survey of adults in Dallas, TX, assessing sunscreen-related knowledge, behavior, and information source. RESULTS: Each respondent averaged 2.5 ± 1.7 hours of self-reported sun exposure daily with the least reported time being 0.15 hours. Eighty-eight percent reported that sun exposure caused skin cancer "a lot." Eighty-nine percent "agreed" or "strongly agreed" that "sun exposure causes most signs of skin aging." Over 70% "agreed" or "strongly agreed" to an appearance-based reason for their sunscreen use. Sixty-six percent reported they would consider using sunscreen if anticipating sun exposure lasting 2 hours or less. Only 30% reported using sunscreen daily. Greater photoaging knowledge was positively associated with sunscreen adherence (at least P < 0.05 with each knowledge item). Those with darker complexions or skin less likely to burn reported less knowledge of photoaging (ρ = -0.219, P ≤ 0.001) and had lower sunscreen use (ρ = 0.301, P < 0.001). CONCLUSION: Despite most respondents reporting knowledge of health and appearance risks of sun exposure and a motivation to prevent them with sunscreen, most do not use sunscreen adequately. This discrepancy could be due to people perceiving risks of sun exposure based on duration of continuous exposure. There may be misconceptions that short-interval sun exposure that does not result in sunburn is less harmful than extended exposure.

Microbiological and Clinical Studies of Legionellosis in 33 Patients with Cancer.

Legionella, a large group of environmental Gram-negative bacteria, represents an occasional cause of pneumonia. We analyzed the microbiological and clinical features of 33 consecutive cases of Legionella infections that occurred at the University of Texas MD Anderson Cancer Center, Houston, TX, from 2002 to 2014. The Legionella strains were isolated from bronchoscopy specimens (32 strains) and a blood culture (1 strain) and were identified by sequencing analysis of the full-length 16S rRNA gene. The 33 strains involved 12 Legionella species or subspecies: 15 strains of L. pneumophila subsp. pneumophila, 3 strains of L. pneumophila subsp. fraseri or L. pneumophila subsp. pascullei, 4 strains of "L. donaldsonii," 3 strains of L. micdadei, and one each of L. bozemanae, L. feeleii, L. gormanii, L. longbeachae, L. maceachernii, L. parisiensis, L. sainthelensi, and Legionella sp. strain D5382. All patients except one asymptomatic carrier showed pneumonia, including one with concurrent bacteremia. Nine patients died, with this infection being the immediate cause of death in six. Twenty-seven patients had underlying hematologic malignancies. Twenty-three patients were leukopenic. Six patients were recipients of allogeneic hematopoietic stem cell transplant, with their infections caused by five Legionella species. Together, these results suggest that diverse Legionella species infect patients with cancer in the Houston area and its vicinity. The five cases of pneumonia due to L. donaldsonii and Legionella sp. D5382 are likely the first reports of human infection with these organisms.